All articles

W. L. Hamilton and R. Wenlock
Antimicrobial Resistance (AMR) is an increasing problem in the treatment of many pathogenic microorganisms, and can be intrinsic to the pathogen or acquired. Here, we provide an overview of the causes and consequences of AMR using illustrations from bacterial species that have a major impact on UK healthcare, such as Methicillin-Resistant Staphylococcus aureus (MRSA), Extended-Spectrum β-lactamase (ESBL)-producing organisms, and Carbapenemase-Producing Enterobacteriaceae (CPE). Bacteria can quickly evolve AMR due to short generation times allowing rapid evolutionary change, and horizontal transfer of genetic material between strains. The resulting arms race between bacterial evolution and human pharmaceuticals is one that modern medicine is currently losing, with potentially disastrous consequences for patient outcomes, public health, and healthcare macroeconomics.

The CMJ are pleased to annouce the winner of the 2015 photo competition as Roisin O’Dea. We had a high number of excellent entries and it was difficult to pick just the one. We will be uploading the runner up images shortly. Click to view the winning entry.

P. Boothroyd, E. Lee , E. Sweet, A. Stillie, E. Cameron, Y. Cao, A. MacArthur, H. Zakaria, J. Cameron
Adjuvant breast radiotherapy (RT) is associated with acute skin toxicities including erythema and desquamation that may be associated with a detrimental impact on patients’ quality of life. Management of radiation-induced skin reactions (RISR) is contentious due to conflicting literature. There is a lack of evidence for the use of aqueous cream although this is commonly used in UK cancer centres. Alternative preparations such as Moogoo udder cream® are more expensive and may be more efficacious. The aim of this study was to investigate patient experience of RISRs and determine whether they would be willing to purchase a cream not provided on the NHS, should one be demonstrated to be more efficacious.

R. Price, R. Gilhespy, K. Hartop, S. Jack, E. Simpson and A. Stillie The evolution of healthcare spans centuries and reflects the way in which new knowledge has been applied and subsequently integrated into medical practice. There has been a distinct shift towards a mutualistic approach to delivering healthcare. Physicians must address increasingly complex patient expectations and ensure that patients understand their medical conditions. Providing solely verbal information has long been recognised to result in poor patient recall1, however identifying and developing a model to ensure the effective delivery of medical information is proving more challenging. Can one approach fit all?

R. L. Lambson
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating condition characterised by intense long-lasting fatigue and affects 0.2-2% UK population. In addition, a more significant burden to UK health is the fatigue is commonly associated with many chronic diseases. Over 17.5 million people within the UK currently suffer with a chronic disease (1), a figure which is set to rise with the aging population. Those with an attributable cause for their fatigue, such as chronic diseases, are unable to access NHS CFS services. Despite this, NHS services dedicated to the fatigue occurring outside CFS/ME are lacking. This leaves many people without the support and access to the multidisciplinary team that they need.

K. J. Bhat MD, H. J. Samoon MD and R. Shovkat MD
The clinical course of dengue haemorrhagic fever in the elderly is rather atypical and it is imperative to be aware of the protean manifestations and complications of dengue febrile illness in this age group. Rectus sheath haematoma, in the context of acute emergency presentations is uncommon, especially in the patients on anti-coagulation therapy. Bilateral rectus sheath haematoma is rarely seen.

We present the first case of spontaneous and bilateral rectus sheath haematoma complicating dengue haemorrhagic fever in an elderly male. This case emphasizes the fact that serious complications can occur during the defervescence phase, especially in the elderly, and that a high index of supervision and suspicion should be maintained by the clincians.

F. Brown
In 1979, Nobel laureate Francis Crick published a paper discussing progress in neuroscience. Describing the subject as “profoundly mysterious”, he speculated on new methods of investigating the brain, including the ability to inactivate one type of neuron whilst leaving the others “more or less unaltered” [1]. Crick is not alone; for years the mammalian brain has dumbfounded researchers [1,2]. In the human, a hundred billion neuronal parts and myriad connections lead to an interconnected system of a level of unparalleled complexity [3]. This system is responsible for poetry, music and art and gives rise to consciousness, memory and countless other phenomena. It is also the victim of a vast array of devastating pathologies [4].

On 15th November a new Cambridge-based organisation, Polygeia, held their inaugural conference on global health policy. Polygeia’s mission is to empower students to participate in global health discussions through policy research and discussion. Already, work has been produced on neglected tropical diseases, mental health, global health partnerships, sexual and reproductive health and pharmaceuticals. The type of work done ranges from literature reviews to opinion pieces to project evaluations. Through undertaking a wide range of work with support from academics and professionals from around the world, the second aspect to Polygeia’s mission is to develop the skills of those students involved.

We are happy to once again be supporting the Edinburgh University Neurological Society (EUNS) for their 3rd Annual conference, to be held on Saturday 7th February, 2015. The conference will involve keynote speakers specialising in ageing, CJD and paediatric neurosurgery, along with workshops on Surgery and Neurotrauma, Careers in Neurology and Neurosurgery, Neuroscience Lab Skills and Science Communication. There is also a poster and oral presentation session

The World Health Organization estimates that neurological disorders currently affect one billion people worldwide, a number which is predicted to increase considerably as a result of an ageing population. The need to further understand the brain and make progress in the field of neurology has therefore never been greater. However, with over 100 million neurons each making over 1000 synapses, the human brain is undoubtedly the most complex organ in the human body, and it is this complexity that has meant that advances in neuroscience have been comparatively slow.